Stillbirth is a relatively common yet poorly understood condition, with rates as high as 6-7/1000 live births in the US. This proposal describes the San Antonio Center for the Study of Stillbirth, a collaborative study group combining the basic and clinical research expertise of the University of Texas Health Sciences Center at San Antonio (UTHSCSA) and the epidemiologic prowess of the San Antonio Metropolitan Health District (SAMHD). The specific aims of this proposal are: (1) to describe the catchment area of the San Antonio Center for the Study of Stillbirth;(2) to describe the study personnel and the study capabilities of the San Antonio Center for the Study of Stillbirth;and (3) to describe a contemporary scientific approach in a sample study of the impact of maternal diabetes as a cause of stillbirth. In San Antonio, there are approximately 24,000 deliveries per year, with a fetal death rate of 5.3/1000 live births. From 1995-1999, there were an average of 115 fetal deaths in San Antonio per year with about 25% of these occurring at University Hospital, the primary hospital for the academic faculty at UTHSCSA. About 60% of women with fetal death are of Hispanic ethnicity, reflecting the population demographics of the area. The SAMHD ascertains all fetal deaths in the area through death certificates filed by hospitals, and has recently established a Fetal and Infant Mortality Review board. The proposed P.I. and co-P.I, have extensive experience in the design, implementation, and performance of large collaborative multicenter trials. Several computerized databases are available for this study. The study coordinator is an experienced public health nurse who coordinates fetal death surveillance for SAMHD. A surveillance and patient identification system is described, employing all study personnel and collaboration of local hospital systems. The sample study is a multifaceted approach to determine the mechanisms of fetal death in women with diabetes, employing proteomics and other contemporary scientific techniques. At UTHSCSA, several nationally known consultants with cutting-edge technology have expressed interest in participating in the study protocol. All major hospital systems in the area have provided letters of support for participation in this study, as have all private perinatologists in the city. UTHSCSA and SAMHD, with cooperation of local health care systems, have the resources, skill, and dedication to study the demographics and causes of the vast majority of stillbirths in the San Antonio area.